Provider Demographics
NPI:1972877025
Name:YAWS, JENNIFER JENELL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JENELL
Last Name:YAWS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 847692
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-7692
Mailing Address - Country:US
Mailing Address - Phone:903-416-1726
Mailing Address - Fax:903-416-1701
Practice Address - Street 1:6601 W I 40
Practice Address - Street 2:SUITE 300
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-2651
Practice Address - Country:US
Practice Address - Phone:806-331-7905
Practice Address - Fax:806-731-1516
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP121586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8121NKOtherBCBS
TX359590ZHVZMedicare UPIN